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Pal N, Banu HN, Chakraborty M, Jain N, Maiti PK. Current perspective of adrenal histoplasmosis in India: A prospective study in a tertiary care hospital, Eastern India. Indian J Med Microbiol 2022; 43:90-95. [PMID: 36272878 DOI: 10.1016/j.ijmmb.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Adrenal histoplasmosis (AH) is an uncommon form of disseminated histoplasmosis caused by the dimorphic fungus Histoplasma capsulatum. Though, India is considered to be a non-endemic area for histoplasmosis, a high rise of AH cases is reported currently from various parts of India. Our study aimed to evaluate the current perspective of adrenal histoplasmosis in India by reviewing its clinical course, differential diagnosis, treatment, and mortality of our eleven confirmed cases of AH along with the review of authentic reported AH cases from India. MATERIAL &METHOD Clinical materials were taken from radiologically suspected all 15 cases either with unilateral or bilateral adrenal enlargement, referred between 2018 and 2020 for microbiological investigations. Fungal stain and fungal culture along with other tests for possible differential diagnosis with AH were conducted. RESULT Out of fifteen incidentaloma detected by radio-imaging, eleven cases of AH had been diagnosed in our hospital with yield of Rhodotorula spp. in one mimicking case. Nine of them were male (82%) and all were HIV nonreactive, which corroborates with the literature review. All of them had nonspecific clinical presentation of chronic abdominal pain, fever, weight loss, and anorexia. Four developed primary adrenal insufficiency, which are similar to the literature review (41%). On treatment with itraconazole and/or amphotericin B, all patients survived except one lost in follow-up. CONCLUSION Male preponderance and non-compromised immune status are two special characteristics of most AH though reasons are ill understood. So, mycological investigations are to be done for every such case.
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Affiliation(s)
- Nupur Pal
- Department of Microbiology, Institute of Post-Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata 700020, India.
| | - Hossain Najma Banu
- Department of Microbiology, Institute of Post-Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata 700020, India
| | - Mohana Chakraborty
- Department of Microbiology, Institute of Post-Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata 700020, India
| | - Namrata Jain
- Department of Microbiology, Institute of Post-Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata 700020, India
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Sanha V, do Valle Barbosa GRG, Miranda B, Bastos RH, Pasqualottoa AC. Epididymo-orchitis caused by Histoplasma capsulatum. Med Mycol Case Rep 2022; 37:4-7. [PMID: 35651534 PMCID: PMC9148929 DOI: 10.1016/j.mmcr.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
Abstract
A 66-year-old man presented with asymptomatic right testicular swelling. He was known to be infected with HIV and was non-adherent to treatment. He was recently treated for nasal leishmaniasis. Surgical drainage was performed and eventually, an orchiectomy was required. A post-mortem diagnosis was made of disseminated histoplasmosis. Testicular infection due to H. capsulatum is rare, with only a few cases being reported. Here we present a case of testicular histoplasmosis, followed by a literature review.
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Roy M, Roy AK, Upalakalin JN, Ahmad S. Isolated Non-Resolving Vulvar Lesion as a Presentation of Disseminated Histoplasmosis in a Woman with HIV. Eur J Case Rep Intern Med 2020; 7:001814. [PMID: 33083360 DOI: 10.12890/2020_001814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 11/05/2022] Open
Abstract
Disseminated histoplasmosis is most commonly caused by Histoplasma capsulatum and is a known opportunistic infection in immunocompromised patients. The clinical presentation of histoplasmosis varies from asymptomatic to a progressive disseminated form. Pulmonary and CNS involvement is common in disseminated histoplasmosis. Rarely, disseminated disease can present as vulvar lesion in the absence of pulmonary symptoms, causing a delay in diagnosis. As per our PubMed literature search, there have only been two reported cases where vulvar lesion was the only presenting symptom of disseminated disease. In our patient, a histopathological diagnosis was made with staining showing budding yeast forms of histoplasma. LEARNING POINTS Histoplasmosis can be a cause of isolated non-resolving vulvar lesion in immunocompromised patients.In patients at risk, we recommend work-up for disseminated histoplasmosis with urine histoplasma antigen and further imaging to rule out disseminated infection when histoplasma is identified on local biopsy samples.In patients from endemic regions and in non-resolving vulvar lesions, fungal infection should be considered.
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Affiliation(s)
- Moni Roy
- Department of Internal Medicine, University of Illinois College of Medicine, OSF Saint Francis Medical Center, Peoria, Illinois, USA
| | - Ashish Kumar Roy
- Department of Internal Medicine, University of Illinois College of Medicine, OSF Saint Francis Medical Center, Peoria, Illinois, USA
| | | | - Sharjeel Ahmad
- Department of Internal Medicine, Section of Infectious Diseases, University of Illinois College of Medicine, Peoria, Illinois, USA
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Botero-García CA, Faccini-Martínez ÁA, Uribe E, Calixto OJ, Pérez-Díaz CE, Osejo-Diago PP, Franco-Maz PG. Epididymo-orchitis caused by Histoplasma capsulatumin a Colombian patient. Rev Soc Bras Med Trop 2018; 50:868-870. [PMID: 29340471 DOI: 10.1590/0037-8682-0267-2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/11/2017] [Indexed: 11/21/2022] Open
Abstract
Although histoplasmosis is generally a self-limited disease, disseminated infection can occur in patients lacking effective cell-mediated immunity, reaching virtually every organ, even the genitourinary tract in rare cases. We report a case of epididymo-orchitis in an immunocompetent 38-year-old bricklayer from the rural area of Villeta, Cundinamarca, Colombia. The patient presented with testicular pain and macroscopic scrotal changes requiring a left orchiectomy, with microbiological isolation and molecular confirmation of Histoplasma capsulatum.
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Affiliation(s)
| | - Álvaro Adolfo Faccini-Martínez
- Postgraduate Program in Infectious Diseases, Health Science Center, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.,Committe of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología, Bogotá, Colombia
| | - Erika Uribe
- Servicios y Asesorias en Infectología, Bogotá, Colombia
| | | | - Carlos Eduardo Pérez-Díaz
- Servicios y Asesorias en Infectología, Bogotá, Colombia.,Infectious Diseases Department, Hospital Universitario de la Samaritana, Bogotá, Colombia
| | | | - Pedro Gabriel Franco-Maz
- Pathology Department, Hospital Universitario de la Samaritana, Bogotá, Colombia.,School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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Kathuria S, Capoor MR, Yadav S, Singh A, Ramesh V. Disseminated histoplasmosis in an apparently immunocompetent individual from north India: a case report and review. Med Mycol 2013; 51:774-8. [DOI: 10.3109/13693786.2013.777166] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Subbalaxmi MVS, Umabala P, Paul R, Chandra N, Raju YS, Rudramurthy SM. A rare presentation of progressive disseminated histoplasmosis in an immunocompetent patient from a non-endemic region. Med Mycol Case Rep 2013; 2:103-7. [PMID: 24432229 DOI: 10.1016/j.mmcr.2013.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/12/2013] [Accepted: 04/15/2013] [Indexed: 11/24/2022] Open
Abstract
Histoplasmosis is an important systemic fungal infection in endemic areas. In India, the disease has been reported from several parts of the country, most cases being from eastern India considered to be endemic for the disease. There have been very few cases reported from the state of Andhra Pradesh, in the southern part of India. We report a case of progressive disseminated histoplasmosis presenting with bleeding manifestations in an immune competent patient from the state of Andhra Pradesh.
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Affiliation(s)
- M V S Subbalaxmi
- Department of General Medicine, Nizam's Institute of Medical Sciences, Hyderabad 500082, Andhra Pradesh, India
| | - P Umabala
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad 500082, Andhra Pradesh, India
| | - Roshni Paul
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad 500082, Andhra Pradesh, India
| | - Naval Chandra
- Department of General Medicine, Nizam's Institute of Medical Sciences, Hyderabad 500082, Andhra Pradesh, India
| | - Y S Raju
- Department of General Medicine, Nizam's Institute of Medical Sciences, Hyderabad 500082, Andhra Pradesh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Baig W, Attur R, Chawla A, Reddy S, Pillai S, Rao L, Rao G, Ashok K, Yegneswaran P. Epididymal and prostatic histoplasmosis in a renal transplant recipient from southern India. Transpl Infect Dis 2011; 13:489-91. [DOI: 10.1111/j.1399-3062.2011.00660.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Endemic mycoses are important fungal infections in their respective habitats. In the Asia-Pacific region, an accurate epidemiological picture of endemic mycoses is elusive; few epidemiological surveys have been performed, and limited laboratory facilities and experience with fungal infections have further hampered recognition of infection. However, pockets of endemicity do indeed exist, and endemic fungal infections can have a significant impact on public health. This article reviews the most common endemic mycoses in the Asia-Pacific region: histoplasmosis, penicilliosis, and sporotrichosis. Blastomycosis, which has been infrequently reported within the region, is also briefly discussed. Certain areas of the Asia-Pacific region are endemic for histoplasmosis; however, the ecologic niche for this infection remains unclear. Penicilliosis is restricted to Southeast and Eastern Asia, whereas sporotrichosis is encountered in tropical areas of the Asia-Pacific region linked to environmental reservoirs distinct from those seen in the Western world. Before the advent of acquired immune deficiency syndrome (AIDS), histoplasmosis and penicilliosis were only occasionally reported; however, the incidence of both mycoses has increased with the rise in the incidence of AIDS. Comprehensive studies are needed to fully assess the areas of endemicity and the impact of endemic mycoses in the Asia-Pacific region.
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Affiliation(s)
- A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
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Histoplasma capsulatum recovery from the urine and a short review of genitourinary histoplasmosis. Mycopathologia 2009; 167:315-23. [PMID: 19184526 DOI: 10.1007/s11046-009-9182-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 11/08/2007] [Indexed: 10/21/2022]
Abstract
Although virtually any organ can be involved in disseminated histoplasmosis, the recovery of Histoplasma capsulatum from the urine is a rare finding. Here we describe that a renal transplant recipient had H. capsulatum recovered from urinary sediment. The organism was also recovered from urine cultures. The potential implications of this finding are discussed, and the literature on genitourinary histoplasmosis is reviewed.
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Wise GJ, Talluri GS, Marella VK. Fungal infections of the genitourinary system: manifestations, diagnosis, and treatment. Urol Clin North Am 1999; 26:701-18, vii. [PMID: 10584612 DOI: 10.1016/s0094-0143(05)70212-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There is an increasing pool of immunocompromised patients who are at an increased risk to fungi infections, which now cause 8% of nosocomial infections. Premature infants and elderly, transplant, and HIV patients are prime candidates for invasive fungal infections. The genitourinary system can be a source or target of disseminated fungal infection. Although candidal species are the most frequent pathogen, other species such as aspergila, cryptoccoccus have become major pathogens. "Environmental fungi," which include blastomyces, coccidioides and histoplasma, have become more aggressive in the vulnerable patient.
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Affiliation(s)
- G J Wise
- Division of Urology, Maimonides Medical Center, Brooklyn, New York, USA.
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